Graco was founded nearly 70 years ago, and Evenflo and Child Craft have been around even longer. In fact, most of the prominent baby supply manufacturers have been in the baby business for decades, so I am always appalled when their products are recalled. Haven’t they perfected the art of manufacturing safe baby products yet? Drop-down side cribs are the latest example in faulty designs. In the past year, manufacturers announced the recall of many drop side cribs. Ultimately, last week, the Consumer Product Safety Commission completely banned drop-down side cribs  because they have been implicated in the deaths of at least 32 infants since 2001. 

Recalls occur slowly. Here’s an example. My husband and I discovered some of the plastic pieces which held up the mattress support for our firstborn’s crib had cracked in half when we tried to set up the crib for our second born. Thinking we had used too much force to snap the pieces into place, we simply ordered more parts and put the crib together. Not until after my third child was born, five years after my first, did a recall on this crib go out. Other families experienced some of the pieces snapping while babies were in the cribs and the mattresses fell to the ground.

Through the years, I’ve noticed most recalls are only for a handful of reasons. Look at your children’s toys and equipment for these potential dangers before the recall occurs:

• Head entrapment – The most common story is that the baby slides through a leg hole of a stroller or baby carrier and his neck gets stuck. A baby also may strangle when his neck is wedged between parts of a piece of equipment. This problem occurred with drop-down side cribs. The recommended width between crib rails is 2 3/8 inches (the width of a soda can) because a child is more likely to trap his head in any larger of an opening.  Make sure there are no openings or potential openings larger than 2 3/8 inches.

• Choking – Any part that can be pulled off and fit into a toilet paper tube is a choking hazard.

• Restraint failure – Equipment is often recalled for inadequately restraining a baby, e.g. loose swing straps.

• Lead ingestion – Lead needs to be consumed to cause poisoning so anything your baby chews on, including railings, are suspect. Lead check kits are readily available; the one I use is leadcheck.com.

If your child is injured because of faulty equipment, even with an injury which seems inconsequential, remember to report the problem to the consumer product safety commission and to the manufacturers.  

Forget waiting for the recall. It could be years. Don’t buy something that makes you suspicious in the first place.

For more baby proofing hints, please see our post The In’s and Out’s of Baby proofing.

© 2010 Two Peds in a Pod℠

Dashing through the mall, having traded your one-horse open sleigh for a minivan, you have secured gifts for all creatures, including the mouse. Now you are ready to  leave on a plane tomorrow to spend the holidays with forty of your closest relatives.

How will you avoid illness this holiday season? How best to travel with children? We take you to a couple posts to help you out: Traveling with Children, and A happy, healthy holiday part 2: more holiday sanity hints .

We wish you all good health this season.

Julie Kardos, MD and Naline Lai, MD

©2010 Two Peds in a Pod℠

Today our dear friend, pediatrician, and mom, Wendy Lee shares insights and personal experience on how to tell your child he is adopted.

My husband and I had waited three long years for “the phone call” letting us know who would become our baby.  Only three short weeks prior to boarding a plane to China, we got the news we would not be bringing just one beautiful girl home from China, but TWO. Twins. We should have known right at that moment we would begin living a life of improvisation.

As with all parenting, there are endless numbers of issues to tackle.  One unique to families formed by adoption is how and when to tell your child he is adopted.  There are many differing opinions on how to do this right, but all agree children should be told.  It wasn’t so long ago that “the experts” deemed it to be psychologically damaging for a child to know about his adoption, and recommended not revealing this information.  Thankfully, things have evolved, and we are faced not with if, but how, to best share the news about adoption.

Just as with many aspects of child rearing, it is often best to take cues from your child.  If your child is younger, as were our girls (thirteen months old at the time we first met them), it is a good time to discuss adoption openly so it takes on a normalcy.  We read a full library of children’s books to them about adoption, and show the girls pictures and videos of our trip over and again.  We speak with them about our “Gotcha Day” (the day we got them and they got us).  And we celebrate this day each year with some of the families who traveled to China and got their daughters on the same day.  We talk about their birth parents in China and celebrate their heritage which, although similar to ours, is not exactly the same (I am Korean, and my husband is Cambodian). 

We gave ourselves a little pat on the back one day when we told our children one of our friends was going to have a baby, and they in turn asked which plane the parents were going to ride to get the baby.  They certainly thought adoption was a normal way to have a baby, but now we were faced with telling them other ways this could happen!  

As children grow, they enter new stages which may require improvisation.  A child’s age and temperament will guide you in your discussions regarding her birth and adoption.  Some children will never have any questions and will be satisfied with the here and now.  Others will have lifelong struggles to try and understand their history.  At certain stages, children will want nothing else but to fit in.  Being adopted, at that point, may set them apart from others and become something they will not want to advertise.  While “Gotcha Day” right now is another opportunity for our girls to have cupcakes, presents, and company, at some point it may be a day that reminds them of what they have lost and how they are different from their friends. They may choose not to celebrate this day any longer.  For some children, curiosity about their birth parents will be all-consuming and for others, it may just bring fleeting thoughts. 

Regardless of the age, stage or temperament of your child, my advice is to be truthful, open, supportive and positive. As your child grows, you will share more information. At some point, probably during his/her adolescence, your child should be given all the information that is known regarding his or her history, even if it may be difficult to share.   Discussions will move from simple explanations to potentially heart-wrenching, tear-ridden sessions where answers aren’t available.  I think whatever reaction your child will have to this part of her past, the longer she has to process it, and the longer you have to deal with your child’s emotions in this regard, the better it will be for all.

Wendy C. Lee, MD, FAAP
General Pediatrician

Presently full-time mama to two beautiful twin girls adopted from China

Anxiously awaiting a third child from Korea

© 2010 Two Peds in a Pod℠

Breastfeeding moms often ask us what medications they can take and not adversely effect the baby. The most complete database we have found is LactMed . Hope you won’t  have the need to refer to it too often.

At a baby’s six month old check-up I advise parents to have their child start drinking from a cup.

Some respond with surprise,” A cup? So young? How exciting! Do you mean a sippy cup?”

“No,” I explain. “A regular, open face cup.”

Then I get incredulous looks. “But how will our baby manage that?”

Just like your baby “learns” how to eat food off a spoon, she will have to practice. You will have to help her at first. Just put water in the cup. Who cares if water spills? You see how by this age she naturally puts her hands together and pulls most things to her mouth. With practice, she will learn to drink out of a cup. Just like everyone else did before sippy cups were invented.

“But when,” parents ask me, “should we introduce the sippy cup?”

The reality is, sippy cups satisfy a parent’s desire to be neat and to avoid mess. Sippy cups are not a developmental stage. Did I use sippy cups with my own kids? Yes I did, especially with my twins, because anything I could do to decrease mess in my home I welcomed with open arms. But it is perfectly okay to never introduce sippy cups to your child.

Because sippy cups are spill-proof,  it is tempting to leave one out all day for your child. If the cup contains water, this practice is safe. However, many toddlers have ended up with a mouth full of cavities in their brand new baby teeth after sipping milk or juice all day long out of sippy cups. Constant sweet substances on the gums can sink in and affect baby teeth. Just as we advise parents of bottle fed babies to avoid allowing the child graze from the bottle all day and to avoid falling asleep drinking a bottle, young children should not be drinking sugar-containing drinks, including milk, all day from a sippy cup.

“But I only give my kids water mixed with a tiny bit of juice in the sippy cups,” I hear parents say. Yes, kids (and grownups) need water, but watered down juice is not the same as plain water. Watered down juice is sugar water, and it harms teeth just like straight-up juice. In addition, drinking watered down juice teaches kids that all beverages need to be sweet. Sweet drinks do not actually quench thirst; rather, they make kids feel thirstier. Remember that unlike adults, babies and toddlers have not formed unhealthy habits yet, so teach them that water and milk are for drinking. The only exceptions are electrolyte solutions that are used to prevent dehydration during vomiting and juice once a day (prune, pear, or apple) for constipated children. For nutrition, fruit is much healthier than fruit juice.

So put water in the open faced cup and allow your baby to imitate you and drink out of it. Then, around your child’s first birthday when most parents wean their children from breast milk or formula to cow milk, put the “big boy milk” or “big girl milk” into a cup.  Aim for all open cups by at least two years of age. If you decide to use sippy cups, as I did, for neatness sake, do not forget practice with a regular cup. Get rid of the sippy cup whenever you are tired of washing those moldy valves and tired of rescuing them from your drain or garbage disposal.  You might have a “sippy cups are for car rides” policy and use open cups at home.

What about straw cups? Well, think of it this way. Do you plan to travel around with straws in case your child becomes thirsty? Sure it’s fine to teach your child to drink out of straw. It’s healthier than a sippy cup because most of the milk will bypass most of the teeth. But again, it is easiest in the long run to teach your child to drink out of a regular cup so that in any situation you know you can offer your child a drink.

All kids are messy. The younger you practice with your child, the sooner she will be drinking out of a regular cup like a pro. Just in time for finger feeding which means self-feeding—more mealtime mess!

Julie Kardos, MD with Naline Lai, MD
©2010 Two Peds in a Pod℠

Two Peds in a Pod turns today to guest blogger Dr. Alan Woolf, Director of the Pediatric Environmental Health Center at Children’s Hospital Boston and president-elect  of the American Academy of Clinical Toxicology, to tackle the question, “Should you feed your kids organic fruits and vegetables?”

Nutritionists are urging parents to feed kids one and one-half cups of fruit and two and one-half cups of vegetables daily and the American Academy of Pediatrics suggests whole fruit rather than juice to meet most of the daily fruit requirements. 

OK, so that’s fine, but why spend a lot more money to buy those fruits and veggies labed organic? Are they worth it? Will non-organic produce harm your kid? No easy answers here. American consumers demand a bountiful supply of blemish-free, perfect fruits and vegetables. We want unspotted shiny red apples, brightly colored large oranges and arrow-straight asparagus. Farmers want to give us just that. Since pests attack crops causing blemishes, worms, blight, and other forms of costly crop damage, farmers have been using pesticides for years to increase crop yield, profit, and visual marketability. 

The US Dept of Agriculture (USDA) regulates the agricultural procedures and labeling that use the buzz word organic. Obviously every business wants to put that word on their product if it means consumers will run out and buy it. The USDA will certify farms that use organic methods. But even the USDA’s definition of organic allows a percentage of synthetic chemicals to be added to products labeled organic. Also organic does not mean that the food contains increased amounts of essential minerals and vitamins or is more nutritious for you. And remember that organic produce doesn’t necessarily come from small, cuddly, local, family-run farms. Most large, international agribusinesses are touting organic foods for sale these days.

Well over one billion pounds of pesticides, according to the Department of Agriculture, are used on American crops annually. And pesticides tend to be nasty chemicals—otherwise they wouldn’t kill bugs. In large amounts, some types can cause seizures or coma in people. However, all foods , whether organic or non-organic, must contain pesticide residues well below the standard that the government considers safe. Not every piece of non organic fruit even contains a residue; it’s hit and miss.

But what about the long-term safety of pesticides in trace amounts, the amounts barely present as micro-grams or nano-grams? The fact is that no one knows the safety for sure. The science just isn’t there yet. Some dispute the government’s definitions; arguing that children don’t eat the same market basket as adults (they eat more fruit). They reason that using adult pesticide residue standards may not protect children. Recently some scientists did a study where they measured pesticide residue in the urine of school-aged children who were fed regular, market-basket produce, and then measured again after they switched them to organic-only fruits and vegetables. Guess what—kids fed organic foods excreted less pesticide residues in their urine. There’s a powerful argument for organic. 

One thing that everyone agrees with—wash all of your fruits and vegetables after you buy them and before anybody in your family eats them. And that means soap and water, not just a quick rinse. Also keep in mind that infants and children are resilient even in this modern age filled with all sorts of hazards. Kids and adults are armed with marvelous defense mechanisms that prevent chemicals from doing bodily harm. Even if a chemical does cause some injury, the body has remarkable mechanisms that repair the damage in a hurry. No need to be “chemical phobic;” you can’t keep your kids in a bubble.

That being said, you still need to be cautious. In pediatrics we often invoke the “precautionary principle.” The idea is that if you don’t exactly know what a chemical will do to a child’s health because there aren’t enough scientific studies out there, then you assume that what it is capable of is bad and so, if possible, try not to expose them, just as a precaution. 

When you can, buy from local farms or stands where you can ask them their growing practices, or else just grow your own. If you decide to buy organic foods, you should eat them right away. They may not stay edible as long without preservatives. Again, no matter what type of food you buy, wash, wash, wash.

Finally, alternative “greener” farming techniques, integrated pest management (IPM), and more resistant varieties of plants have increased crop yields, in many cases without using as much pesticide. That’s good news for all of us. Breeding of genetically-engineered plants require less use of pesticides, but they may not be acceptable to most consumers. That’s a whole column in itself!

The bottom line: My wife and I will try to buy organic foods when we think of it, but we don’t obsess over it when we forget. 

Alan Woolf, MD, MPH, FAACT, FAAP

Director, Pediatric Environmental Health Center, Children’s Hospital Boston

© 2010 Two Peds in a Pod®

A few days ago, I spoke with the faculty of a local early childhood education center about flu vaccine myths. See how you do on the true and false quiz I gave them:

I can tell when I am getting the flu and will leave work before I infect anyone.

False. According to the CDC (US Center for Disease Control), you are infectious the day before symptoms show up.

I never get the flu so it’s not necessary to get the vaccine. 

False. Saying I’ve never had the flu is like saying, “I’ve never a car accident so I won’t wear my seat belt.”

I hate shots. I hear I can get a flu vaccine in a different form.

True.  One flu vaccine, brand name Flu Mist, provides immunity when squirted in the nose. Non-pregnant, healthy people aged 2-49 years of age qualify for this type of vaccine.

I got the flu shot so I was healthy all year.

False. Perhaps it was the half-hour a day you added to your workout, or the surgical mask you wore to birthday parties, but your entirely healthy winter was not secondary just to the flu vaccine.  The United States flu vaccine protects against several strains of flu predicted to cause illness this winter. This year’s vaccine contain both seasonal and the 2009 H1N1 strains. Your body builds up a defense (immunity) only against the strains covered in the vaccine. Immunity will not be conferred to the thousands of other viruses which exist. On the other hand, the vaccine probably did protect you from some forms of the flu, and two fewer weeks of illness feels great.

My friend got the flu shot last year, therefore, she was sick all winter.

My condolences. True, your friend was sick. But the answer is False, because the illnesses were not caused by the flu vaccine.  Vaccines are not real germs, so you can’t “get” a disease from the vaccine. But to your body, vaccine proteins appear very similar to real germs and your immune system will respond by making protection against the fake vaccine germ. When the real germ comes along, pow, your body already has the protection to fend off the real disease. Please know, however, there is a chance that for a couple days after a vaccine, you will ache and have a mild fever. The reason? Your immune system is simply revving up. But no, the flu vaccine does not give you an illness.

I got the flu vaccine every year for the past decade. I will still need to get one this year.

True. Unfortunately, the flu strains change from year to year. Previous vaccines may not protect you against current germs.

I am a healthy adult and not at high risk for complications from the flu, so I will forgo the flu vaccine this year.

False. The flu vaccine is now recommended for everyone greater than 6 months of age. When supply is limited, targeted groups at risk for flu complications include all children aged 6 months–18 years, all persons aged ≥50 years, and persons with medical conditions that put them at risk for medical complications.   These persons, people living in their home, their close contacts, and their CARETAKERS are the focus of vaccination. 

Even if I get the flu, I’ll just wash my hands a lot to keep the germ from spreading. I have to come back to work because I don’t have much time off.

False, According to the American Academy of Pediatrics Report of the Committee on Infectious Diseases, the influenza virus can spread from an infected person for about a week after infection.

Yes, kids get sick from others kids, but as a parent who comes in contact with two children, an early childhood educator who comes in contact with ten children, an elementary school teacher who comes in contact with twenty children or a high school teacher who comes into contact with one-hundred children daily, you may end up the one who seeds your community with a potentially deadly illness.  Right now, flu vaccine clinics are as plentiful as Starbucks. Hit that CVS or Walgreens on the way home, wander into your doctor’s or grab a shot while you get groceries.  By protecting yourself from the flu, you protect the children you care for.

Naline Lai, MD with Julie Kardos, MD

© 2010 Two Peds in a Pod℠

Picture this: you are going back to work after a too-short maternity leave. Briefcase? Check. Lunch? Check. Breast pump? Check. Photo of your baby to put on your pump for inspiration? Check.

Many moms ask how to continue breastfeeding when they return to work. Because babies should receive breast milk or formula for at least their first year, here is how you can incorporate breastfeeding into your work routine:

Offer bottles by four weeks of age. Bottles can contain breast milk or formula, but you need to give your baby practice taking milk from a bottle by four weeks old. If you wait much longer, your baby will likely refuse the bottle. Have someone other than yourself give at least one bottle per day or every other day. In this way, your baby learns to accept nutrition from someone else.

Store breast milk using the simple and conservative “rule of twos.”  Leave breast milk in a bottle at room temperature for no more than two hours, store breast milk in the refrigerator for no more than two days, and store in the freezer for no more than two months. If your baby has already sucked out of a breast milk bottle, that milk is only good for up to two hours. Remember to write the date on your milk storage bags and use the oldest ones first.

Now select from the following breast feeding menu, understanding that you might start with option 2 or 3 and then change to option 4. The best option is the one that works best for you and your baby.

Option 1: Continue to breast feed at work. This option works for moms who work from home, moms who have child care in their work setting, and moms close enough to dash home to breast feed during the day or who have caregivers willing to drive babies over to work for feedings.

Advantage: no pumping, no buying formula, no bottle washing. Disadvantage: may require some creative scheduling.

Option 2: Breast feed when home and pump and store breast milk at work. Have child care givers offer stored breast milk in bottles. This method allows moms to provide exclusively breast milk to their babies. Start pumping after the first morning feeding (or any other feeding that you feel you produce a bit more than your baby needs for that particular feeding) beginning when your baby is around four weeks old. Also pump if your baby happens to sleep through a feeding. Store this milk in two or three ounce amounts in your freezer. You can obtain breast milk freezer bags from lactation consultants and baby stores, or you can store milk in zip lock bags.  As you continue to pump after the same feeding each day, your body will produce more milk at that feeding.

Once you have some breast milk stored and you are a few days out from returning to work, try pumping during the feedings you will miss while at work. Have someone else feed your baby breast milk bottles for these feedings. Finally, when you return to work, continue to pump at the same schedule and leave the stored breast milk for your child’s caregivers. Consider leaving some formula in case caregivers run out of breast milk. Remind them never to microwave the milk (this kills the antibodies in breast milk as well as creates a potential burn hazard) but rather to thaw the milk by placing in a hot water bath.

This method becomes easier as babies get older. Once babies start solid foods, they breast feed fewer times per day. Somewhere between six to nine months, your baby eats three solid food meals per day and breastfeeds four or five times per 24 hours. Thus, the number of times you need to pump decreases dramatically.

Advantage to this option: breast milk with its germ-fighting antibodies given through the first year and no expense of formula. Disadvantage: having to pump at work.

Option 3: Breast feed before and after work and give your baby formula while you are at work.  If you do not pump while at work, your body will not produce milk at these times. If you work full time, then on weekends you might find it easiest on your body to continue your “work time” feeding schedule. If you choose this method, wean your baby from daytime breast feeding over that last week or so before returning to work. Suddenly going a long time without draining your breasts can lead to engorgement, subsequent plugged ducts, and mastitis.

Advantage: baby continues to receive breast milk. No need to pump at work. Disadvantage: you still have to wash bottles and have the added cost of formula.

Option 4:  Breast feed until you return to work, then formula feed. Wean over the last week you are home with your baby to avoid engorgement and leaking while at work. Your baby still benefits from even a few weeks of breast milk.

Advantage: No need to incorporate pumping into your work schedule.  Baby still gets adequate nutrition. Disadvantage: babies who are in childcare and exposed to many germs miss out on receiving extra antibodies in breast milk. However, weaning your baby off breast milk will not cause illness. Do what works for your family. Also, more expensive to buy formula and time-consuming to wash bottles.

Pumping should not take longer than 15 minutes if you’re pumping both breasts at the same time and can take as short as 7-10 minutes. Remember to wash your hands before pumping.

What kind of breast pump should you buy/rent? If you are in it for the long haul, we recommend the higher-end electric double pumps with adjustable suction. Ask the hospital nurses, your midwife, or your obstetrician for names of people who rent or sell pumps in your area.

Finally, remember that the calorie count and nutritional content of breast milk and formula are the same. So do NOT feel guilty if pumping does not pan out and you and end up giving some formula. Your baby is almost always going to be more efficient than a breast pump and some breasts just don’t produce milk well during pumping sessions. In contrast, some of my patients never got the hang of breast feeding and their moms pumped breast milk and bottle fed them for the entire first year. Dr. Lai and I have each had patients who refused to take a bottle at childcare but just waited patiently for their moms to arrive. These babies got what they needed by nursing throughout the night. The babies didn’t mind what time of day they ate. Just like many aspects of parenting, sometimes with breast feeding, you just have to “go with the flow.”

Julie Kardos, MD with Naline Lai, MD
2010 Two Peds in a Pod®

My patient looked up at me.  “Do you want to see what I can do?” she asked.

Her father mockingly moaned, ”Oh, no.”

“Pleeease,” persisted the girl, “just once.”

The dad just laughed.

“Watch,” she said proudly as she suddenly rolled her eyeballs back and flipped her eyelids inside out with her fingers.

 
“Very impressive,” I told her, and snapped a photo.

__________________________ 

Voluntary eye movements like the one in the photo may be ugly to look at but are not damaging.  Nor will the child’s eyes be forever stuck in that position. On the other hand, any involuntary eye movement should be investigated. 

In particular, be vigilant for lazy eye (strabismus).  In this condition, the eyes are do not align correctly and drift. According to the most recent edition of Nelson Textbook of Pediatrics, lazy eye affects about four percent of children under six years of age and can manifest itself in infancy.

By two months old, your child’s eyes should be able to fix on your face and move together as she watches you. If you notice her eyes cross beyond this age, take her to her doctor. Lazy eyes tend to run in families. The child pictured immediately here has several relatives with lazy eyes. 

The cause of most lazy eye is unclear; however some cases are due to a defect in the pathways of the brain and nerves which control eye movement. Occasionally, some types are associated with other medical problems.

Detection of a lazy eye is important because a “lazy” eye can lose vision (amblyopia) from underuse. Treatment for most kids involves covering the good eye and forcing the lazy eye to “do more work” in order to prevent amblyopia. Ophthalmologists (eye surgeons) use techniques such as covering an eye with a patch, prescribing special glasses, or using eye drops to encourage the use of the lazy eye.  For some, surgery is needed to fully align the eyes. The earlier treatment starts, the more rapid the response.  Unfortunately, after a child is eight years old, treatment is much less effective.

Shortly after the girl showed me her eye rolling talent, a boy in the office showed me another intriguing trick.  By inhaling deeply, the boy sucked in one nostril until it flattened without pulling in the other one.  

Didn’t take a picture of that one.

Naline Lai, MD with Julie Kardos, MD

©2010 Two Peds in a Pod℠

A concerned parent wrote to us: